Knowledge is Power: Taking Control of Your Menopause Journey with Education
During the menopausal transition, women often experience a range of confusing and uncomfortable symptoms, leaving them feeling unheard and frustrated by their doctors' inability to help. Unfortunately, the symptoms of menopause are frequently overlooked by physicians, resulting in unnecessary suffering for women. Despite this issue being well-known, medical students continue to receive insufficient exposure to menopausal patients, and the trend persists into residency programs. Shockingly, even Obstetrics and Gynecology residents, who are expected to be experts in women's health, receive menopause training in only 1 out of every 5 programs. Given that over 50 million postmenopausal women live in the United States, this lack of healthcare knowledge has a profound and negative impact on the quality of life for midlife women. Although there is a small movement working to educate women and healthcare providers about menopause, much work still needs to be done to close this gap in healthcare knowledge.
Menopause is a term used to describe the absence of a menstrual period for at least one year, and it typically occurs around the age of 51 for women in the US. Prior to reaching menopause, many women experience a transitional period known as peri-menopause, during which their bodies undergo changes in response to declining levels of reproductive hormones. While peri-menopause is most commonly experienced by women between the ages of 45 and 55, some women may begin to experience these changes as early as their late thirties or early forties. Because menopause can only be diagnosed retrospectively, it can be challenging to recognize when a woman is going through peri-menopause.
During menopause, a woman's body stops ovulating, leading to a significant decrease in estrogen levels. In contrast, during peri-menopause, the body still attempts to ovulate, but there are fewer viable eggs available, resulting in significant hormonal fluctuations. The decline in estrogen levels during peri-menopause is not a linear process; instead, it often fluctuates leading to times of increased estrogen followed by times of significantly decreased estrogen, which can be a source of confusion for women experiencing symptoms. These hormonal waxes and wanes that cause increased estrogen levels at times, can lead to prolonged and pronounced premenstrual syndrome (PMS) symptoms such as breast pain, bloating, and migraines.
Women experience differing degrees of menopausal symptoms. Symptoms of menopause include:
Hot flashes
Night Sweats
Irregular Periods
Mood Changes
Breast Soreness
Decreased Libido
Vaginal Dryness
Headaches
Tingling Extremities
Burning Mouth
Changes in Taste
Fatigue
Bloating
Other Digestive Changes
Joint Pain
Muscle Tension and Aches
Electric Shock Sensations
Itchiness
Sleep Disturbance
Difficulty Concentrating
Memory Lapses
Thinning Hair
Brittle Nails
Weight Gain
Stress Incontinence
Dizzy Spells
Allergies
Osteoporosis
Irregular Heartbeat
Body Odor
Depression
Anxiety
Panic Disorder
The duration of peri-menopause typically lasts around four years, but for some women, it can last more than a decade. As a woman approaches menopause, her estradiol levels typically drop to less than 25 pg/mL, and her FSH levels increase to over 30 IU/mL. However, testing hormone levels during this time can be unhelpful and unnecessary as they can fluctuate significantly and randomly during and between cycles. For instance, a woman in her 50s who is having an ovulatory cycle may have hormone levels similar to her 35-year-old counterpart during a single blood draw. Generally, peri-menopause is diagnosed based on a woman's history of menstrual irregularities and/or bothersome menopausal symptoms. Hormonal testing may be helpful in specific circumstances, such as when a woman has a history of polycystic ovary syndrome (PCOS), endometrial ablation, hysterectomy or a progesterone IUD in place.
The good news is that there are many effective treatments available to help manage the symptoms of menopause. These treatments include menopausal hormone therapy, which involves the use of FDA-approved systemic hormones and/or vaginal estrogen. Additionally, cognitive behavioral therapy and hypnosis can also be helpful in managing menopausal symptoms. Non-hormonal medications, vigorous cardiovascular exercise, and strength training exercises are also effective in reducing symptoms. Optimizing nutrition and sleep are also helpful. Additionally, some women *might* benefit from the use of supplements, although it is best to consult with a physician before taking any supplements.
It is important to be cautious of trendy and potentially harmful treatments that are marketed to treat "hormone imbalances" during peri-menopause. Many of these treatments may not have adequate scientific evidence to support their safety or effectiveness. Therefore, it is crucial to seek out a physician who is well-versed in evidence-based, safe treatments for menopause.
Education is key in navigating this time in a woman’s life. By providing accurate information and debunking common myths, women can make informed decisions about their health and well-being. Creating a community of women to exchange ideas, provide support and camaraderie can be immensely helpful during this time. Together, we can continue to promote evidence-based treatments and support each other on this journey.
Selected Sources:
Christianson, MS, Ducie JA, Altman K, et al. Menopause education: needs assessment of American obstetrics and gynecology residents. Menopause. 2013;20(11):1120-5.
Gunter, Jen. The Menopause Manifesto. Citadel Press Kensington, 2021.
Menopause Practice, A Clinician’s Guide, 6th ed. CJ Crandall, Editor-in-Chief. North American Menopause Society, 2019.
